Duke health students receive advice at community day

Sep. 18, 2013 @ 09:16 AM

Out of a snapshot of 1,000 people, only one person will be hospitalized at an academic medical center.

That statistic, according to Duke Dr. Viviana Martinez-Bianchi during Duke’s annual Community Health Engagement Day, shows health care students they need to become more involved in community health advocacy.

The community health event, organized by the Duke Schools of Medicine and Nursing, highlighted community partnerships, research and service projects at the Mary Duke Biddle Trent Semans Center last week.

Martinez-Bianchi, who works within Duke Community and Family Medicine, showed the graph to an audience of medical, physician assistant, physical therapy and nursing students.

On the graph, the one person who would go to an academic medical center like Duke for treatment consisted of a little red dot in a sea of other health care options, such as primary care centers or non-academic hospital outpatient clinics.
“But in that little red dot is where we do most of your training,” Martinez-Bianchi told the crowd, suggesting they become advocates for community policy-making that will combat health care disparities. “Most of what affects patients’ health happens outside of the clinical setting.”
Laura Gerald, who served as North Carolina’s health director, was a guest speaker. She had spent part of that morning working in a Robeson County clinic.
Despite having top-notch hospitals and health care providers in North Carolina, Gerald said, North Carolina is ranked 33 out of the 50 states when it comes to health care outcomes. The state also is ranked 42nd for public health funding per person.
“We really have paradoxical health outcomes here in North Carolina,” she said.
Gayle Harris, who is the director of the Durham County Department of Public Health, also was a speaker. She broke down Durham’s main health care concerns and its successes. 
The county has made strides in combating smoking during pregnancy, drunk driving and suicide, she said.
However, Durham County is ranked fourth in the state for its number of HIV cases. The county is focusing on access to care, HIV and other sexually transmitted infections, obesity, poverty, education, and substance abuse and mental health in the coming years, she added.
“That’s why it is so critical for all of you to bring your voice to these issues,” Harris said. “… We have to empower the people that we work with.”
Howard Eisenson, chief medical officer of Lincoln Community Health Center that serves underrepresented and uninsured people who need health care, spoke to the room of medical students about “Obamacare,” or the Affordable Care Act, leveling the playing field for those who don’t have health insurance.
Eisenson said he saw a 29-year-old patient with no health insurance, severe Chrohn’s Disease, or an inflammatory bowel disease, and a pregnant wife. His patient lost weight and was unable to eat, and then he couldn’t work.
When the patient visited the Lincoln Center, which is one of 34 community health centers in the state, he and his family received the care they needed.
“You better be prepared to be fueled to make a difference,” Eisenson said. “… If I didn’t know it then, I know it now – Poverty is a public health problem.”
The Affordable Care Act Marketplace, which begins open enrollment for health insurance Oct. 1, will provide insurance to millions, he said.
Volunteer with Enroll America, a national effort to enroll uninsured patients in Affordable Care Act health coverage, he told the students. “When you see patients, ask them if they have insurance.”
Julia Gamble spoke to the crowd about homelessness and health care. She works with the Lincoln Health Care for the Homeless Clinic, and she displayed a photo of a bench with a blanket on the screen.
The slide posed questions such as: How do the homeless store their medications? Refrigerate insulin? Maintain a heart-healthy diet?
In January 2013, Durham was home to about 759 homeless people. And for those homeless, Gamble said, their life expectancy is shortened by 30 years.
Her staff is noticing undiagnosed cognitive delays, which could be attributed to traumatic brain injuries. She said one of her patients, who camped downtown, “not far from those yummy places to eat that get written up in Southern Living magazine,” was suffering from undiagnosed cognitive impairments and chronic obstructive pulmonary disease.
He was impatient, but he soon gained a trust with the Homeless Clinic and allowed them not only to help him with his health, but also to access benefits, such as Medicaid, and housing. “He calls us periodically and tells us he loves us, and we tell him we love him,” Gamble said.
When North Carolina decided to opt out of nationwide Medicaid expansion in March, denying health insurance to about 500,000 low-income people, Gamble said her sickest and poorest clients will go without coverage.
“The sickest of the sick and the poorest of the poor may not get benefits,” she said. “And what do we do about it? Vote.”
The panel took questions at the end of the discussion. They encouraged students to get in touch with health organizations around Durham, such as the community nonprofit CAARE, and to get involved in student organizations.
“Advocate within those organizations for change,” Eisenson said, “as big as you can dream.”